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Life

What a Doctor Knows about Death

Dr. M has seen enough to know he doesn't want to be kept alive too long. Or die 'for nothing.'

By David Berner 2 Feb 2005 | TheTyee.ca
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"They don't let you die anymore."

And this is a doctor speaking. A neurologist. Let's call him Dr. M.

A few years ago, a woman who was a patient at Riverview Mental Hospital, hung herself. She'd been up there for a full fifteen minutes before they cut her down. Which means that her brain and her heart and all those other vitals that cause the bleeps on the oscilloscope had been sufficiently starved of blood and oxygen to leave her in what we now agree to call "a vegetative comatose state."

Her father had never visited her in life; but now that she was in near-death, he became Super Dad. He wanted everything humanly possible to be done. She lasted a year and a half.

Intensive care. One-to-one nursing. I.V. drips. Extractors of various bodily fluids. Water to counteract the natural acids that might otherwise eat away the stomach walls. Respirator. Blankets, pans, sheets. Expensive, very expensive medicine.

And you're blocking a bed for someone who might more reasonably survive. Roll the dice. Make a decision. This is not, "Do I get the sourdough or the rye?"

Candidate

A young girl is shot by her mother's boyfriend. The killer kills himself. The girl's brain is pouring out of her skull. She was an athlete and a scholarship student. She still has nice color, very pretty. "Sleeping Beauty," they all say. Now, the medical team, knowing with considerable certainty that this story is going in one direction only, wants to harvest her organs. Kidneys, cornea, heart - all might find second lives in new stand-by bodies. But what is left of the girl's family can't bear it, can't bear anything today, can't bear this thought and that. So, you call the transplant team and inform them, "The girl is not a candidate."  The girl is not a candidate. Not Liberal, Conservative, Republican, Democrat. Not a candidate.

Coma

"We're not there to kill anybody," says Dr. M. "But you can't stop anyone from dying."

Ask yourself the question. Someone you love is in ICU. Deep coma. There is little chance of "meaningful" survival. Do you stand in the hallway amid the clatter of oxygen canisters and debate the measure of "meaningful" survival? Of course, you do. Someone in the family - third cousin twice removed (Why would anyone live in Cleveland, for goddsakes?) - heard of a miracle in such a case. Well, a similar case. I mean, it sounded very much like this. Oprah said. Nobody wants to let go. We can't just let her go. Yet. Yet! What about her suffering? What about our suffering? It's an insult to dignity.

Dr. M. is clear. "Most people wouldn't want this kind of survival for themselves. I wouldn't. But everybody is different. Maybe my wife would make a different choice."

Mercy

ALS is a degenerative disease. So easy to say. A degenerative disease. But what it means is this: the mind is clear and the body is gone. Can't sign cheques is one thing; can't swallow is another. You want this? Why would someone want to die with indignities? Is "mercy killing" really killing? If you have cancer, the doctor can give you morphine. The doctor can give you enough morphine to place you beyond this veil of suffering. But, why should doctors take this on themselves?

We are conflicted at the best of times. We decry "paternalism," but at the moment of truth, we ask the doctor to make the decision.

The Question

Dr. P has intestinal cancer. He's young, in his early 40's. He has accepted his situation. He has made a conscious decision for himself. DO NOT RESUSCITATE. He has spoken to his children. He has laid out the prognosis and The Plan. And now, having put his world in order, he refuses to see his children. He is letting go. He is gone.

Dr. M is clear. "I don't want to die while my father is still alive. I don't want to inflict that kind of pain on someone I love so dearly. So, my instructions are also DO NOT RESUSCITATE. But, I tell you honestly, I don't want to die for nothing. Do we get the answers? I would hate to die without learning the answers…."

David Berner is an actor and hosts a radio talk show on CKNW 980 Sundays, 2 to 5 p.m.  [Tyee]

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